Gliederung

Objective: Both hypothermia and decompressive craniectomy have been proposed as treatment of severe traumatic brain injury. Results of some recent clinical trials suggested lack of neurological improvement after decompressive craniectomy The goal of our experiment was to determine whether the selective brain hypothermia could impact the effect of craniectomy after brain trauma.

Results: According to NSS there was a significant impairment among all the groups subjected to trauma (CHI: 4.63Â±2.06, p < 0.01; CHI+DC: 6.84Â±2.1, p < 0.001; CHI+DC+H: 4.41Â±1.8, p < 0.05) when compared to sham animals (1.38Â±0.52). The animals subjected to both trauma and craniectomy performed significantly worse (CHI+DC: 6.84Â±2.1, p < 0.001) than animals with craniectomy alone (DC: 2.71Â±1.51). This deleterious effect disappeared when additional hypothermia was applied (CHI+DC+H: 4.41Â±1.8, ns). BBS was significantly worse in CHI group (2.33Â±1.35, p < 0.05) and in CHI+DC group (2.63Â±1.53, p < 0.05) but not in CHI+DC+H group (1.5Â±1.41, p > 0.05) when compared to the sham group (0.67Â±0.47).

Conclusions: There was synergistic deleterious effect of mechanical and surgical trauma consistent with results of recent clinical trials reporting, that early decompressive craniectomy was associated with more unfavorable outcomes. Selective brain cooling applied after trauma and craniectomy effaced the negative effect of additional surgical trauma on neurological function. Therefore the local hypothermia may be a very promising alternative to complication-burdened systemic hypothermia. The potential of this treatment option should be explored in clinical feasibility study.